The Debate Around PDA

PDA is not clinically recognised as a condition, which means a child cannot receive a diagnosis of PDA on its own. There is a debate about how the characteristics of persistent demand avoidance relate to autism (and other conditions) and whether grouping these characteristics as PDA is useful. 

The criticisms of the term PDA are that some believe there isn't enough research evidence to confirm PDA as a separate condition and that many of the complex characteristics of PDA can be affected by environmental and social sensitivities which can be addressed.

Counter-criticisms include the argument that critics do not have lived experience of these issues and the views of those with lived experience are invalidated by arguments against PDA. 

One element that most can agree on is that the area needs to be better researched. 

Common Demands

Types of Demand

There are three main types of demand, these are:

• Direct demands - an instruction, such as 'put your coat on'
• Internal demands - a feeling, like recognising hunger or needing the bathroom
• Indirect or implied demands - include expectations, whether social expectations in public places or self-imposed 

Examples of Demands

Examples of indirect or implied demands include:

• Time - Anxiety in response to attending appointments or events on time and being punctual
• Plans - Planning can lead to anxiety nearer the date, while 'spur of the moment' plans create difficulties due to uncertainty
• Questions - The expectations of answers and responses to direct questions
• Decisions - Anxiety around narrowing down and picking options 
• Uncertainty - Needing to feel in control and knowing what is going on
• Praise - Including the implication that a task should be carried out again or improved on next time
• Transitions - A demand to stop and switch to a new activity or environment
• Things your child may want to do - Pressures to fit in hobbies, seeing friends or special occasions

Some situations include small demands within a larger demand. For example, with a larger demand to go to the cinema, your child will be expected to remain seated, respond appropriately, sit next to people they don't know, be quiet, etc. 

Avoidant Approaches

Children who refuse demands may use different levels of avoidance depending on the demand or their capacity at the time. Avoidant behaviour can look like:

• Changing the subject, or distracting the other person
• Procrastination from a task
• Excusing themselves - giving excuses why they can't comply
• Withdrawing 
• Refusing explicitly 
• Shutdowns - a freeze response
• Meltdowns - overt and sometimes aggressive behaviour, a fight response
• Escaping - leaving the situation, a flight response

Find out more about meltdowns and shutdowns here

How to Support Your Child

Each child is different and their experiences with PDA may need flexibility to work out what works best for your family. Some traditional parenting techniques and boundaries may need to be adjusted. You can begin to support your child or young person by:

• Understanding how your child experiences PDA, through reading about the condition and the feelings that can be associated with it, like anxiety and frustration
• Adjusting your expectations to consider how your reactions and parenting style can be altered to support your child
• Consider how you communicate your demands with your child, you could try to make demands more fun or change your language to make them less direct
• Reconsider rewards, praise and sanctions and how your child could perceive these as further demands
• Support your child's sensory needs, through supportive toys, visual aids or adjustments to your home environment
• Think about previous challenging situations and how you can approach the same situation again. You could speak to your child or young person and look for solutions together
• Support your child's emotional wellbeing by helping them to fit relaxation and mindfulness into their routine

Find out how to support your child with PDA here

Parent Experiences

Parenting children with PDA can require you to be more flexible in your parenting approach. It might be necessary to explore alternative approaches when normal parenting techniques don't seem to be effective.

Examples of parent's experiences include:

• 'Demands aren't bad per se, but too many can cause problems and result in a meltdown'.
• 'Try and have a joint decision-making process so that when a demand is made, your child may not respond dramatically'.
• 'Agree on the non-negotiable rules and boundaries. If you can give clear reasons for these boundaries and agree on them together, then this can help.'
• 'When a rule cannot be compromised, it can be helpful to remove the personal aspect and explain why it is needed. We often use sentences like 'Sorry it's due to health and safety' but don't explain why those rules are in place.'
• 'We always have an exit strategy and so does the school. We support our child to know how to appropriately remove themselves from an anxiety-provoking situation. Together with the school, and at home, we understand our child may need to avoid a stressful situation, but you need to agree on an appropriate way to do this together. For instance, you might agree on a quiet zone where a young person can retreat. You can also provide reassurance that if something can't be done today, it can be tried another time.'
• 'My son does not like praise and this can be a trigger point, particularly personal praise can be overwhelming as it feels like an expectation and we handle it very sensitively.'
• 'Rewards can create a demand in themselves as there is a lot of pressure to do well to get the rewards. Surprise rewards work a lot better for us.'
• 'My child has difficulties with sanctions or consequences. This often escalates as she feels out of control when the sanction is given to her. When she calms down, we find it useful to talk through ways to avoid these situations arising in future. We will ask for her views on what she thinks she could have done differently, or what she would feel is a fair outcome.'